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Operative Eingriffe in der Geburtshilfe beinhalten mehrere Besonderheiten, auf die bei der Erstellung des Operationsberichtes geachtet werden muss. Da sich geburtshilfliche Masnahmen oft aus einer kombinierten, Mutter und Kind umfassenden Ursache ableiten, muss sich aus der Diagnose und insbesondere der individuell darzustellenden Indikation die Gewichtung hinsichtlich Mutter und Kind ergeben. Weiterhin wird in der Geburtshilfe – ahnlich zur Gynakologie – zwischen Notfall- und Elektiveingriffen differenziert. Zusatzlich wird aber auch zwischen absoluten und relativen sowie primaren oder sekundaren Indikationen unterschieden. Insbesondere sekundare Indikationen stellen aufgrund der engen zeitlichen Spielraume eine besondere Herausforderung fur die klinischen Ablaufe dar und sind entsprechend detailliert aufzuschlusseln.

Die Praeklampsie gilt als eine der haufigsten schwerwiegenden Schwangerschaftskomplikationen, deren Folgen nicht selten eine erhohte fetale und maternale Morbiditat und Mortalitat sind. Unumstritten ist, dass sowohl fur die Frau als auch fur den Feten die fruhe Erkennung und eine optimale neonatologische Versorgung von grosem Nutzen sind. Schon lange wird nach Methoden gesucht, um eine bessere Risikoeinschatzung vornehmen zu konnen und so den Zeitpunkt fur notwendige Interventionen wie die Entbindung einschatzen zu konnen.

Objectives To examine whether pathological perfusion in the second trimester is characterized by an altered plasma antioxidant capacity and to investigate whether the total antioxidant capacity in maternal plasma is related to the clinical outcome of these high-risk pregnancies. Methods This was a prospective cohort study that included 25 pregnancies with normal and 25 pregnancies with pathological uterine perfusion. Doppler ultrasound measurement of uterine perfusion was performed between 18 and 23 weeks of gestation. Total antioxidant capacity in maternal plasma was measured using a specific photometric assay. Results Plasma antioxidant capacity of pregnant women with pathological uterine perfusion (227.3 ± 4.0 µmol/L) was significantly lower compared with the group with normal uterine perfusion (275.2 ± 10.5 µmol/L; P < 0.05). There was a significant negative correlation between antioxidant capacity and mean pulsatility index of the uterine arteries (r = −0.363; P < 0.05). Patients with pathological perfusion and a normal course of pregnancy did not show significantly changed values compared with those patients with later pre-eclampsia or intrauterine growth restriction (235.0 ± 4.9 µmol/L vs. 218.6 ± 6.7 µmol/L). Conclusions Second-trimester pregnancies with pathological uterine perfusion are characterized by a decreased antioxidant capacity in maternal plasma. This reduction is related to the impaired uteroplacental blood flow, but does not reflect the changes characteristic of the oxidative status for diseases like pre-eclampsia since the reduction of the plasma antioxidant capacity is not related to the clinical outcome of these high-risk pregnancies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Preeclampsia and intrauterine growth retardation (IUGR) are associated with elevated concentrations of myeloperoxidase (MPO) and polymorphonuclear (PMN) elastase, which indicate maternal neutrophil activation. The aim of the study was to measure maternal MPO and PMN elastase plasma concentrations in second trimester pregnancies with pathological uterine perfusion that are a high risk group for preeclampsia and IUGR, and compare them to normal controls.The study includes 25 pregnancies with normal and 25 pregnancies with pathological uterine perfusion. In both groups, doppler-sonographic measurement of uterine perfusion was performed in the twenty-first week of gestation. Maternal plasma concentrations of MPO and PMN elastase were measured using a specific ELISA for both enzymes.The plasma MPO concentration of pregnant women with normal perfusion did not differ significantly from that of the group with pathological perfusion (27.4 +/- 3.3 vs. 23.7 +/- 2.0 ng/mL). Likewise, the plasma PMN elastase-concentration also did not show a significant difference between the groups (5.7 +/- 0.5 ng/mL normal vs. 8.0 +/- 1.0 ng/mL pathological). Patients with pathological perfusion that later developed preeclampsia or IUGR (9/25) showed unchanged MPO and PMN elastase values in the second trimenon compared to those with pathological perfusion and normal outcome.Pathological uterine perfusion in the second trimester was not associated with maternal neutrophil activation. The measurement of the MPO and PMN elastase concentration suggested that neutrophil activation in preeclampsia or IUGR is a secondary effect of the disease rather than a primary pathophysiological factor.